Distinction between contrast staining and hemorrhage after endovascular stroke treatment: one CT is not enough

Dekeyzer, Sven; Nikoubashman, Omid; Lutin, Bart; Groote, J De; Vancaester, Evelien; Blauwe, Sofie De; Hemelsoet, Dimitri; Wiesmann, Martin; Defreyne, Luc

doi:10.1136/neurintsurg-2016-012290

Cited by 56 publications

(50 citation statements)

References 25 publications

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“…Infarct fogging is distinct from contrast staining, where the infarction is masked or even mistaken for hemorrhage by recent contrast administration (ie from previous cerebral angiogram) [5], [8], [9], [10]. Both entities can appear similar with pseudonormalization of infarcted parenchyma on NCCT; but, fogging is a subacute process and staining typically happens in the more acute time period [1], [2], [5], [8]. However, infarct contrast staining, and fogging are not mutually exclusive.…”

Section: Discussionmentioning

confidence: 99%

“…The infarctions in cases 2 and 3 increased in size and conspicuity on consecutive follow-up exams; poor initial visualization could be partially due to serial contrast enhanced CTAs ordered for the evaluation for vasospasm which is a customary practice at our institution. In cases of contrast staining, repeat CT imaging in 24 hours may be required to show infarction extent in the absence of contrast [8].…”

Section: Discussionmentioning

confidence: 99%

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Appearance of cerebral infarct fogging on CT perfusion

Braileanu

Weinberg

et al. 2019

Radiology Case Reports

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Fogging is a deceptive phenomenon that can partially or completely obscure a subacute infarct on noncontrast head CT. We present the appearance of infarct fogging on CT perfusion through 3 cases. At time of fogging, the subacute infarctions demonstrated variable mean transit time with increased cerebral blood volume and cerebral blood flow on CT perfusion. Fogging occurred within 6-10 days, sooner than the previously described 2-3 weeks in classic fogging. At time of fogging, CT perfusion demonstrated a “luxury-like” perfusion pattern and augmented the identification of the true extent of the infarction at time of fogging.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Appearance of cerebral infarct fogging on CT perfusion

Braileanu

Weinberg

et al. 2019

Radiology Case Reports

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“…In all patients DECT was performed within 60 minutes of the procedure. Another 24-48h follow-up exam (brain MRI or conventional brain CT) was also obtained [24][25].…”

Section: Patientsmentioning

confidence: 99%

“…Brain Computed Tomography (CT) right after a neurointerventional procedure may show hyperattenuating areas with a frequency varying across studies between 16% and 85% after intra-arterial revascularization by thrombolysis [8][9][10] and/or thrombectomy [4,7,8,[10][11][12]. They are found in 20 to 50% of patients after intravascular treatment of cerebral aneurysms [3,[13][14].…”

Section: Introductionmentioning

confidence: 99%

Differentiation between Cerebral Hemorrhage and Contrast Extravasation Using Dual Energy Computed Tomography after Intra-Arterial Neuro Interventional Procedures

Zaouak

Sadeghi

Sârbu

et al. 2020

Journal of the Belgian Society of Radiology

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To evaluate the value of dual-energy computed tomography (DECT) in differentiating cerebral hemorrhage from blood brain barrier (BBB) disruption after neuro-interventional procedures with intraarterial injection of iodinated contrast material. Material and methods: This prospective study was approved by the local ethics committee, and informed consent was obtained for all patients. Thirty five patients with acute ischemic stroke or un-ruptured brain aneurysm who had received intra-arterial administration of iodinated contrast material were evaluated using DECT at 80 and 150 kV immediately after the procedure. A three-material decomposition algorithm was used to obtain virtual non-contrast (VNC) images and iodine overlay maps (IOM). A follow-up examination (brain magnetic resonance imaging MRI or conventional CT) was used as the standard of reference for hemorrhage, defined as a persistant hyperdensity on a conventional CT or T2* hypo-intensity on brain MRI. The diagnostic values of DECT in differentiating hemorrhage and iodinated contrast material were obtained. Results: Mixed images obtained with DECT showed intra-parenchymal or subarachnoid hyperattenuation in 18/35 patients. Among these, 16 were classified (according to VNC images and IOM) as contrast extravasations and two with a mixture of hemorrhage and contrast material. On follow-up imaging, there were two patients with hemorrhage. The sensitivity, specificity, and accuracy of DECT in the identifying hemorrhage was calculated as 67% (2/3), 100% (32/32) and 97% (32/33) respectively. Conclusion: DECT allows an early and accurate differentiation between cerebral hemorrhage and BBB disruption after intra-arterial neuro-interventional procedures.

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“…In principle, it is difficult to differentiate parenchymal hyperdensity resulting from contrast staining from hemorrhagic transformation on immediate postinterventional CT (Ͻ24 hours) due to the similar Hounsfield densities of the lesions. 1,2,8 Although early diagnosis of hemorrhagic transformation after endovascular treatment is crucial, it may be differentiated from contrast staining only via follow-up CT (24 -48 hours). In this study, we were interested in differentiating contrast staining from hemorrhagic transformation using DWI and gradient recalled-echo (GRE) imaging.…”

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confidence: 99%

MR Imaging for Differentiating Contrast Staining from Hemorrhagic Transformation after Endovascular Thrombectomy in Acute Ischemic Stroke: Phantom and Patient Study

You

Kim

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Early differentiation of contrast staining from hemorrhagic transformation in patients with acute ischemic stroke who have undergone endovascular treatment is critical in preventing the delayed administration of antiplatelet agents. We aimed to demonstrate the usefulness of an immediate postinterventional DWI protocol including B 0 and gradient recalled-echo sequences to discriminate those 2 conditions through phantom and preliminary retrospective patient studies. MATERIALS AND METHODS: On 3T MR imaging, the signal intensities of the phantom models consisting of iodinated contrast agents diluted with normal saline and arterial blood were compared using T1WI, T2WI, and gradient recalled-echo sequences. A total 17 patients (8 with hemorrhagic transformation and 9 with contrast staining; 8 men and 9 women; mean age, 72.00 Ϯ 10.91 years; range, 52-90 years) who underwent mechanical thrombectomy for acute ischemic stroke and showed newly appearing hyperdense lesions on immediate (Ͻ24 hours) postinterventional nonenhanced CT scans were included in this study. Immediate postinterventional DWI of patients were compared. RESULTS: In the phantom study, iodinated contrast agents diluted with normal saline showed minimal signal drop, while those diluted with arterial blood demonstrated dark signal intensity in the T2WI and gradient recalled-echo sequences. In the patient study, all hemorrhagic transformations and none of the contrast staining demonstrated dark or low signal (Ͻgray matter) intensities similar to those of the vessel in the B 0-DWI and gradient recalled-echo images. CONCLUSIONS: According to our preliminary results, contrast staining might be differentiated from hemorrhagic transformation using an immediate postinterventional DWI protocol including gradient recalled-echo sequences. It might be possible to expedite establishment of postinterventional medical treatment strategy. ABBREVIATIONS: CT FU ϭ postinterventional (24-72 hours) follow-up nonenhanced brain CT; CT imme ϭ postinterventional (Ͻ24 hours) nonenhanced brain CT; GRE ϭ gradient recalled-echo; IODBL ϭ iodinated contrast agents diluted with arterial blood; IODNS ϭ iodinated contrast agents diluted with normal saline

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Distinction between contrast staining and hemorrhage after endovascular stroke treatment: one CT is not enough

Cited by 56 publications

References 25 publications

Appearance of cerebral infarct fogging on CT perfusion

Appearance of cerebral infarct fogging on CT perfusion

Differentiation between Cerebral Hemorrhage and Contrast Extravasation Using Dual Energy Computed Tomography after Intra-Arterial Neuro Interventional Procedures

MR Imaging for Differentiating Contrast Staining from Hemorrhagic Transformation after Endovascular Thrombectomy in Acute Ischemic Stroke: Phantom and Patient Study

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